MEDICARE: FAIR OAKS REHABILITATION AND HEALTH CARE CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	0043422	IL

General Provider Information

NPI Number	:	1578563441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIR OAKS REHABILITATION AND HEALTH CARE CENTER, LLC

Provider Business Mailing Address
First Line	:	1515 BLACKHAWK BLVD
Second Line	:
City	:	SOUTH BELOIT
State	:	IL
Zip	:	61080-2227
Country	:	US
Telephone Number	:	815-389-3911
Fax Number	:	815-389-0565

Provider Business Practice Location Address
First Line	:	1515 BLACKHAWK BLVD
Second Line	:
City	:	SOUTH BELOIT
State	:	IL
Zip	:	61080-2227
Country	:	US
Telephone Number	:	815-389-3911
Fax Number	:	815-389-0565

Authorized Official
Title or Position	:	PRESIDENT, CEO
Name	:	JOSEPH C TUTERA
Credential	:
Telephone Number	:	816-444-0900

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	04/23/2021

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